Shunt adjustment and a hopeful sign

Dr. Bergsneider adjusted Susan’s lumbar shunt to relieve her hydrocephalus today. There’s a valve about the size of a watch battery located under the skin in her right lower back. He found it difficult to position the magnetic adjustment tool over the valve and know for sure he changed the setting, so he did his best and sent Susan to have a couple of x-rays taken for confirmation. The x-rays showed the adjustment didn’t work, so he scheduled her for an afternoon procedure using a real-time digital imaging system called x-ray fluoroscopy. The instant feedback allowed him to place the tool in the right spot and know he had the right setting. Usually these are cranial shunts with the valve located under the scalp and are adjusted easily. With Susan’s lumbar shunt there’s no hard base under valve and lots of tissue around it, so he really had to push and prod to get it done.

He prepared me for the possibility that the shunt may be blocked, in which case today’s valve adjustment won’t help. If her shunt is blocked, it would be troublesome because a surgical replacement can’t be done when a patient like Susan is being treated with Avastin. It causes bleeding that prevents wounds from healing. The alternative could be a series of lumbar punctures (spinal taps) to drain the fluid manually, but even these could pose a bleeding problem. We didn’t dwell too long on these what-ifs. We’ll know within a few days whether her symptoms improve and will take it from there. We already had a hopeful sign this evening when Susan was more alert and spoke more than she has in weeks. Hopefully, the fog is lifting.